Psychological crisis and emergency response in public health emergencies: a case study of the Mpox epidemic

Abstract

Background

The frequent occurrence of social infectious diseases not only threatens the lives and health of the public but also brings about a more serious psychological crisis for the public. Understanding the public’s psychological reactions during public health emergencies is crucial to developing an effective crisis management strategy.

Methods

This study focuses on the monkeypox epidemic and uses Python to crawl the topic data on monkeypox on Weibo. It uses social cognitive theory and sentiment analysis methods to analyze the public’s sentiment values and psychological crisis reactions at different stages. It also comprehensively examines the relationship between different emotions during the epidemic.

Results

The study found that the external environment is the basis for the public psychological crisis. Different subjects have different cognitions, determining the intensity of emotional reactions. In particular, the lack of social identity has aggravated the public’s negative emotions towards infected people. Of course, different emotional responses are interrelated and have different intensities at various stages.

Conclusion

Social norms and effective crisis management strategies are crucial to shaping the public’s emotional response and alleviating psychological crises. Moreover, promoting the disclosure of real information and controlling the spread of rumors can effectively lessen the panic caused by the epidemic. By exploring the public’s accurate psychological crisis response, this article provides suggestions and references for the government to actively intervene in the public psychological crisis during the epidemic.

Introduction

At present, with the frequent occurrence of public emergencies, the mental health of the public has become an important issue that cannot be ignored and needs to be addressed urgently. Monkeypox is one of the typical public health emergencies, and its spread will inevitably directly affect the mental health of the public [1]. Monkeypox is a zoonosis caused by the monkeypox virus of the genus Orthopoxvirus. Since it was first discovered in the Democratic Republic of the Congo in 1970, it has long been confined to parts of Central and West Africa [2]. Therefore, it has not attracted enough attention from the public in other regions. However, since May 2022, the monkeypox virus has crossed geographical boundaries and spread to non-endemic countries and territories. In just over two months, it has spread to more than 76 countries worldwide [3]. This change highlights the evolution of the monkeypox virus’s transmission pattern and poses new challenges to the public health system. This is a new round of the global monkeypox pandemic following the outbreak of COVID-19, which has gradually become a new potential global health threat [4]. In particular, in July, the World Health Organization announced that the monkeypox epidemic was a public health emergency of international concern, placing it at the highest level of alert [5]. In this monkeypox outbreak, the specific population affected by the monkeypox virus was mainly the men who have sex with men (MSM) community, which is not common in previous epidemiological studies. In addition, for the first time, monkeypox virus DNA was found in a wide range of semen tests, providing new clues to understanding its transmission routes. Although monkeypox is generally considered a self-limited disease, it can cause severe complications and even death in immunocompromised individuals [6]. Therefore, early diagnosis and treatment of monkeypox are essential.

In October 2022, the Wuhan Institute of Virology in China successfully isolated the monkeypox virus. With the efforts of all parties to prevent and control the disease and scientific prevention, the spread of the monkeypox virus began to be suppressed to a certain extent. However, the spread of monkeypox has shown a spiral upward trend. It is difficult to monitor and track monkeypox cases effectively, and it is impossible to ensure that the public can use limited vaccines relatively equally [7]. As of December 2023, a total of 93,030 confirmed cases of monkeypox have been reported in 117 countries and regions around the world. On August 14, 2024, the World Health Organization announced for the second time that the monkeypox epidemic constituted an “international public health emergency” [8]. As more and more monkeypox cases were found in non-endemic countries, coupled with the resumption and increase in international air travel, this provided an opportunity for the importation of monkeypox-infected people from different countries, which put the public at risk of infection [9]. The public’s fear of monkeypox gradually spread, and the most intuitive thing was the public’s feelings about monkeypox published on social media. Related topics express negative emotions towards monkeypox patients, which further deepens the panic about the epidemic. To a certain extent, it caused a psychological crisis for the public [10]. Throughout the spread of the monkeypox virus, the public’s psychological state changed in real-time with the spread of monkeypox. The intensity of panic is related to the time and area of epidemic spread, showing prominent spatiotemporal characteristics [11]. To this end, scholars have used online surveys [12] and social platform content [13] to explore the public’s emotions, attitudes, and opinions during the monkeypox epidemic.

So, how did the public’s psychological crisis form and develop during the monkeypox epidemic? And what emergency strategies are there? The key to answering the above questions is to grasp the changes in the public’s emotions, attitudes, and behaviors to explore the public’s cognitive, psychological, and behavioral responses to the monkeypox epidemic [14]. Specifically, it includes the public’s concern about the epidemic, their understanding of epidemic information, and their attitude toward epidemic prevention measures. Based on social cognitive theory, this paper takes the monkeypox epidemic as an example to analyze the formation and development of the public’s psychological crisis in public infectious disease events [15]. In addition, this paper also attempts to summarize the process and experience of the formation of the public’s psychological crisis during the monkeypox epidemic. It proposes feasible solutions to alleviate the public’s psychological turmoil and provides a reference for coping with the psychological risks of infectious diseases in public health emergencies. The research framework of this paper is as follows.

Literature review

Globally, emergencies are becoming more frequent, bringing severe disasters to humanity. They not only threaten the lives and safety of the public but also significantly increase the probability of psychological crises [16]. In 1954 the “psychological crisis” concept was first proposed and systematically studied. Ten years later, Caplan first proposed the theory of psychological intervention based on psychological crisis [17]. Since then, research on psychological crises has gradually increased, mainly focusing on alleviating the public’s social and psychological crises. Among the many emergencies, the most profound impact is the sudden outbreak of public health infectious diseases. Infectious diseases are directly related to the lives and safety of the public. Many epidemics in history have caused tens of thousands of deaths. The origins of emerging infectious diseases are closely related to social, economic, environmental, and ecological factors [18]. In the context of globalization, opening international routes has made cross-border mobility possible, which means that no country can be immune. Strengthening border screening can effectively alleviate the spread of infectious diseases [19].

In May 2022, monkeypox went from being a small-scale periodic outbreak to an epidemic in most parts of the world. The virus directly harms the human body, especially for patients with comorbidities and low immunity, who face the risk of death [2]. Therefore, many scholars have begun to conduct relevant research on the monkeypox epidemic from multiple dimensions, which has improved the understanding of monkeypox and enabled the development of effective intervention measures to control the outbreak [20]. First, from the perspective of monkeypox diagnosis and vaccine research, the symptoms of monkeypox are similar to those of smallpox and chickenpox, so it is essential to adopt accurate and rapid detection methods [21]. However, there is currently no specific effective drug to detect and treat monkeypox patients [22]. In a questionnaire survey of the public, a high proportion of people intended to test for monkeypox, while the proportion of those who agreed to be vaccinated needs to be improved [23]. In particular, special groups with cancer are worried that their condition will worsen [24]. The reason is that they are concerned about safety issues such as vaccine side effects [25]. In addition, the spread of false information about vaccination on social media has turned into anti-vaccine conspiracy theories, which directly undermine the public’s confidence in immunization [26].

Secondly, many scholars have discussed the public’s understanding and views on the monkeypox epidemic. In the first month of the monkeypox outbreak, the general population in Saudi Arabia was more concerned about COVID-19 [24]. Two months later, a survey of communities in Shenzhen, China, showed that more than a third of people were highly concerned about monkeypox and believed that planned health education and psychological intervention were necessary [14]. The public has little basic knowledge of monkeypox, especially in remote areas with a lack of online information [27]. Lack of knowledge will lead to a distorted understanding of the disease, and there is an urgent need for guidance from systematic works on the monkeypox epidemic [28]. In a survey of three continents, medical students in different countries had significant differences in their views on monkeypox, and nearly half of the students still needed to strengthen their knowledge of monkeypox [29]. In addition, with the spread of emerging infectious diseases and the development of social platforms, more and more people have joined online discussions, and posts about contagious diseases such as monkeypox can directly reflect their concerns and emotions about the epidemic [30]. In the study of the COVID-19 epidemic, based on the analysis of published literature, the three main research topics include surveillance, risk communication, and disease control [31]. Data was collected on many public posting platforms, such as Meltwater and CrowdTangle. The number of posts increased with the outbreak of monkeypox, and users expressed their awareness, questions, and concerns about the epidemic and emergency fatigue [32]. In addition, scholars used deep learning to analyze the emotional changes in Google searches for infectious diseases, showing that the emotions presented by the virus at different transmission stages were different [33]. Of course, the geographical distribution of situational awareness information during a crisis is also very different [34].

In earlier studies of infectious disease epidemics, scholars extracted Twitter communications during the San Diego hepatitis A outbreak. They used topic-based rooted topic analysis to find that government policies were criticized by the public, which directly affected risk perceptions [35]. During the Ebola outbreak in Africa, the topological structure of social networks on Weibo was quantified to monitor public health emergency network public opinion [36]. So, how can risk information be optimized to promote network communication? By collecting Twitter information about the Zika virus pandemic, it was found that the severity and efficacy of the epidemic would increase public attention and willingness to move forward [37]. During the recent monkeypox epidemic, through analysis of smartphone text data of men who have sex with men, it was found that the sharing and communication of monkeypox information was conducive to promoting community response to the epidemic [38]. In addition, scholars collected posts on monkeypox on Reddit and obtained four topics that the target group was concerned about [39]. However, information about monkeypox on social media may be misleading and cause harm to patients [40]. Analysis of video content on the topic of monkeypox on TikTok found that incomplete or inaccurate information poses potential risks [41], especially when online discussions contain stigmatization of specific groups of people, and this misinformation threatens public health work [42].

Finally, after discussing the public’s perception of the monkeypox epidemic based on social media platforms, more attention should be paid to the psychological crisis that the public may experience during public health emergencies. With the development of information technology and the popularization of the Internet, each person expresses their opinions on social media as an independent individual. The logic behind this is to convey psychological feelings such as depression, anxiety, and fear [43]. These psychological crises may lead to severe consequences, such as psychological emergency response disorders [16]. Many scholars have explored the psychological distress of the population after significant epidemics, such as the MERS coronavirus in South Korea [44], SARS in Taiwan [45], Zika virus [46], and equine flu in Australia [47]. Compared with these small-scale epidemics, there are more studies in this field during COVID-19. Most of them are further explorations of existing literature. Scholars use systematic reviews and meta-analyses to derive the types of psychological reactions after the outbreak, which are mainly negative emotions such as anxiety, anger, and depression [48]. As the epidemic spreads, the number of patients with mental problems continues to increase [49]. In addition, based on information on social media platforms, pandemic psychological cognition directly affects the shaping of cultural values [50]. Central government support and education can reduce public anxiety and alleviate psychological crises [51]. However, there is little discussion on the psychological turmoil during the monkeypox epidemic. The primary methods used are questionnaire surveys and patient medical record analysis. The UAE people have high levels of worry and anxiety [12], and HIV patients are more likely to show anxiety [52].

In general, most studies only focus on the public’s views and cognition of public health emergencies and mainly discuss the impact of a particular factor in the epidemic on the public. However, there is a lack of systematic analysis of the public’s psychological state and emotional changes under public health emergencies. In particular, existing scholars have specifically explored the formation process of the public psychological crisis of the monkeypox epidemic, and there is a lack of emergency strategies for the psychological turmoil at different stages of the monkeypox epidemic. Therefore, based on social cognitive theory, this study collects data on monkeypox topics on Weibo to explore the process and causes of the public’s psychological changes during the monkeypox epidemic and proposes feasible ways to alleviate the psychological crisis according to the different stages of the spread of the monkeypox epidemic. Analyzing the process of public psychological changes helps formulate more effective health publicity and response strategies, improving the public’s crisis response ability and providing a scientific basis for the practice of public health departments and government mental health services. On the other hand, timely discovery and solving of social panic, rumor-mongering, and other problems avoid the negative impact of the epidemic and promote social stability and order.

Theoretical basis and methods

Theory of crisis cognitive evolution governance

This study combines crisis management theory and social cognitive theory to construct crisis cognitive evolution governance theory (Fig. 1). From the perspective of crisis management theory, this theory is an interdisciplinary research field covering management content such as prevention, response, and recovery [53]. Against the backdrop of the spread of the epidemic, it is easy to cause social and psychological crises. So, how can we better understand the formation and process of the social and psychological crisis caused by the epidemic? Crisis management provides a complete set of methods for crisis awareness, especially its mature crisis life cycle model [54]. In crisis management, individual and group emotional responses, cognitive patterns, and behavioral decision-making are at the heart of understanding crisis response. Therefore, the research on social cognitive theory is integrated into crisis management, emphasizing how individuals and groups can process information, perceive, and make decisions and behavioral responses in a crisis.

Fig. 1.

Theoretical framework

In the 1960s, psychologist Bandura first proposed social cognitive theory, which involves learning, motivation, behavior, and socialization and particularly emphasizes that the external environment and social interaction directly affect people’s behavior [55]. In this theoretical framework [56], the public obtains information about the spread of the monkeypox epidemic through news reports and other channels. It collects information related to the monkeypox epidemic [57]. At the same time, individuals experience the background of the spread of the monkeypox epidemic and understand relevant information. Then, the risk of personal exposure to the epidemic is assessed [58]. When more and more monkeypox cases appear in the surrounding area, the public’s panic may spread further, thus forming a more tense situation. As a result, monkeypox has caused a more significant psychological crisis, which is manifested through major social platforms. However, at different stages of the monkeypox epidemic, there were considerable differences in the areas where it broke out and the number of people infected. In addition, the information about monkeypox is asymmetric. There is much inaccurate information on the Internet, and even some alarmist rumors. The result is that the public’s feelings about the monkeypox epidemic are different in different periods, so there are also significant differences in the psychological crises caused. Thus, this paper is based on the theory of crisis cognitive evolution governance and aims to explore the public’s mental process of monkeypox transmission. Crisis management is used at different stages to predict, prevent, and control social and psychological crisis risks.

Sentiment analysis

Among the many text mining methods, sentiment analysis is a popular natural language research field. With the continuous maturity of machine learning and deep learning technologies, sentiment analysis can handle more and more complex problems. For example, sentiment classification in different scenarios, multimodal sentiment comparison, and implicit sentiment disclosure [59]. This paper mainly uses sentiment analysis methods to conduct sentiment analysis on posts published on social media during the monkeypox epidemic, further to analyze the changes in the public’s psychological crisis. Generally speaking, many studies rely solely on questionnaires to diagnose psychological problems, which makes the research have some shortcomings. First, questionnaires can only target a small number of people and may not be representative. Second, the design of the questionnaire scale is not necessarily scientific. Third, the questionnaire is only for questions and answers at a particular time and cannot represent the entire psychological change process. Fourth, the authenticity of the questionnaire content needs to be verified. To solve these shortcomings, this study crawled the monkeypox topic data in real-time, and this complete sample data is very representative. At the same time, the best way to present the psychological crisis is to publish posts with real emotions. Moreover, the feelings expressed at different stages change, which is conducive to capturing the dynamic changes of social psychological crises.

Much literature has explored this field in analyzing basic human emotions. In particular, the basic emotion theory proposed by Ekman (1987) laid an essential foundation for emotional research [60]. Ekman believes emotions are universal, cross-cultural human responses and identifies six basic emotions: anger, fear, sadness, happiness, surprise, and disgust. In recent years, emotion analysis has gradually gained widespread attention and has derived a variety of emotional vocabulary ontology libraries for more precise classification and analysis of emotions. The emotional vocabulary ontology library of the Dalian University of Technology has carefully classified Chinese emotions, which has realized the systematic construction of emotional ontology. More precise and context-sensitive when dealing with Chinese emotions. Therefore, this paper mainly refers to the Dalian University of Technology sentiment vocabulary ontology library [61] and other sentiment dictionaries [62] to achieve the sentiment analysis of topic data [63]. This study classifies sentiment according to three criteria in deep sentiment analysis. At the first level, it is divided into “positive sentiment” and “negative sentiment.” At the second level, it is divided into seven categories: “anger,” “disgust,” “fear,” “sadness,” “surprise,” “good,” and “happy.” The third level is divided into 21 sub-categories, namely, ‘anger (NA),’ ‘annoyance (NE),’ ‘hate (ND),’ ‘blame (NN),’ ‘jealousy (NK),’ ‘suspicion (NL),’ ‘panic (NI),’ ‘fear (NC),’ ‘shame (NG),’ ‘sadness (NB),’ ‘disappointment (NJ),’ ‘guilt (NH),’ ‘thought (PF),’ ‘surprise (PC),’ ‘respect (PD),’ ‘praise (PH),’ ‘belief (PG),’ ‘like (PB),’ ‘wish (PK),’ ‘happiness (PA)’ and ‘peace of mind (PE)’ [61].

An empirical study on psychological crisis in public health emergencies

Data source

In April 2022, the first case of monkeypox was found in the UK. Subsequently, cases appeared in Belgium, the United States, Australia, and other countries. As the monkeypox epidemic spread around the world, it aroused public fear and concern about the spread of the epidemic, and even gradually formed a public psychological crisis. Therefore, this paper aims to explore the public psychological crisis formation process during the monkeypox epidemic and propose corresponding countermeasures for the public psychological turmoil. This study mainly collects monkeypox Weibo topic data in real-time, from April 2022 to December 2023, with a time interval of 20 months. Weibo is currently one of the most active social platforms in China. Users express their opinions by posting, commenting, forwarding, and liking posts on the Weibo platform, which reflects their psychological state at the time [64]. The data in this article mainly comes from the Weibo platform. As one of China’s largest social media platforms, Weibo has a broad user base, covering multiple age groups and social groups [65]. In particular, Weibo’s “hot search” function can promptly reflect the public’s attention and emotional tendencies toward specific topics. Weibo hot searches have strong social interaction and can quickly capture public opinion changes in emergencies or issues. Therefore, it has become an important data source for studying people’s emotions and attitudes [38]. Weibo crawler is a technical means to obtain information that users post on the Weibo platform through an automated program. The keyword “monkeypox” is entered through the Weibo webpage, and the content of posts related to the topic is collected with the help of Python software.

Although the content of microblogs may be interfered with by relevant reasons [66], this study has taken some measures to ensure the reliability and neutrality of the data. First, this study adopts real-time topic data crawling, thus realizing the collection of original microblogs in the first place. This avoids data loss due to time delay and dramatically improves the authenticity and validity of the data. Second, during the monkeypox epidemic, the government encouraged online mutual assistance activities through social media platforms. As a widely used platform, Weibo has become an essential channel for the public to express emotions and share information [67]. Third, to further enhance the reliability of data analysis, this paper also combined other data sources, such as Google Index and Baidu Index, for cross-validation. Through verifying these auxiliary tools, the accuracy of Weibo data is enhanced, and the research results are ensured not to be affected by systematic bias. In short, this study can effectively guarantee data reliability and obtain representative public sentiment and behavior analysis results through the above collection and verification methods.

In addition, this article only crawls data labeled “monkeypox,” and other topics about the psychological crises are not within the scope of the collection. This avoids the interference of external factors unrelated to the epidemic in this study, thereby achieving a special survey of the psychological crisis brought about by the monkeypox epidemic. However, it is noteworthy that the crisis experienced during the COVID-19 pandemic has shaped the public response to the monkeypox outbreak to some extent [68]. The former may have exacerbated the psychological impact of the latter crisis on certain groups [69]. Although the COVID-19 epidemic has brought tremendous psychological pressure to the world, monkeypox transmission is unique (close contact is required for transmission). This has led to a low perception of its public health threat, affecting the public’s emotional response and crisis management [70]. In conclusion, the public emotional response to the monkeypox epidemic may be affected by the COVID-19 pandemic, but the specific degree of influence may vary depending on personal experience, social background, and the particular nature of the epidemic. This study focuses on the public psychological crisis during public health emergencies, and both epidemics fall into the category of public health emergencies. Therefore, this study does not consider the overlapping effects of the two epidemics. After clarifying and screening the data, 154,868 original Weibo posts, 489,467 comments, and 388,900 forwards were crawled on the Weibo platform. These data will present the entire process of the spread of the monkeypox epidemic and provide data support for the subsequent research on the psychological crisis of the public during the monkeypox epidemic.

Stage division

The spread of monkeypox is a process, and the number of infected people and regions at different stages are different. From this point of view, the public’s understanding of the monkeypox epidemic is changing. Therefore, it is essential to divide the spread of the monkeypox epidemic into different stages [71]. Based on the landmark events in the spread of monkeypox and the trend of Weibo topic postings, this study divides the monkeypox epidemic into five stages, namely: emotional heat budding stage, emotional heat outbreak stage, emotional heat flat stage, emotional heat recurrence stage, and emotional heat subsidence stage (Fig. 2). Emotional heat refers to the intensity and fluctuation of the public’s emotional response to the monkeypox epidemic in a specific period. It reflects people’s expression of concern, anxiety, fear, and other emotions about the epidemic and its changes. It not only demonstrates the breadth of the spread of epidemic information in society but also reveals people’s psychological state, such as fluctuations in panic, anxiety, anger, and other emotions. Changes in emotional heat can help analyze the public’s emotional response and psychological crisis and provide theoretical support for related public health interventions and psychological counseling [72].

Fig. 2.

Monkeypox epidemic stages

From the perspective of the time nodes of the stage division, the first dividing line is July 2022, when the World Health Organization announced that monkeypox was a public health emergency of international concern. At this time, the public’s attention to the monkeypox epidemic reached its peak, and the public’s psychological state was mainly manifested as worry and panic. The second dividing line is October 2022, when China successfully isolated the monkeypox strain, the public’s panic about monkeypox gradually decreased, the psychological state turned from tension to rationality, and the discussion volume about monkeypox continued to be sluggish. The third dividing line is May 2023, when Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, announced that the monkeypox epidemic no longer constituted an “international public health emergency.” However, in June, new cases of monkeypox appeared in Beijing, Guangzhou, Hong Kong, Shenyang and Taiwan. In addition, a large number of asymptomatic infections occurred in the spread of monkeypox, which further increased the public’s fear and led to a surge in discussions about monkeypox during this stage. The fourth dividing line is September 2023, when the National Health Commission of China included monkeypox in the management of Class B infectious diseases stipulated in the “Law of the People’s Republic of China on the Prevention and Control of Infectious Diseases” and adopted Class B contagious disease prevention and control measures. This measure has strengthened the public’s confidence in preventing and controlling the epidemic. As the spread of monkeypox has been significantly suppressed and the number of confirmed cases of monkeypox has gradually stabilized, the public has slowly relaxed their attention to the epidemic, their fear and anxiety about the epidemic have steadily decreased, the amount of discussion has decreased, and life has gradually returned to normal [16].

Analysis of psychological crises at different stages of the Mpox epidemic

Emotional heat begins to rise

In the first phase, the number of monkeypox-related posts on the Weibo social platform surged, and the public’s attitude towards monkeypox was mainly fear and disgust. The proportion and intensity of fear continued to increase. The first confirmed case of monkeypox appeared in the UK, and the number of confirmed cases in other regions continued to grow [73]. In the early stages, the topic of discussion revolved around concerns about the spread of the monkeypox virus to China during the COVID-19 epidemic. As the monkeypox epidemic spread further, the discussion topics shifted to topics such as “monkeypox virus detection capabilities,” “how the virus spreads between people,” and “populations susceptible to the virus.”

The information obtained by the public through the media and social platforms shapes their perception of the epidemic. High-frequency discussions on social media have intensified the public’s emotional reactions and fluctuations, especially promoting the spread of anxiety and fear. When individuals face uncertain threats, they are easily infected by the emotions of others, which intensifies anxiety and fear. From the perspective of the two major categories of emotions (Fig. 3), negative emotions are almost equal to positive emotions in the early stage. In contrast, the intensity of positive emotions is always greater than that of negative emotions in the later stage. This shows that individuals alleviate negative emotions through positive information-seeking and emotional expression when their emotions are high. Of course, with a vast base, negative emotions still account for a large proportion, and the psychological crisis caused by this also needs special attention. Overall, fear and disgust peaked at this stage [2]. This shows that when the public first learned about the monkeypox epidemic, they were often at risk of infection due to their lack of understanding of it. Especially in the context of the COVID-19 epidemic, when faced with the threat of infectious diseases again, the public is more inclined to express and share negative emotions. The public’s emotional response is affected not only by the individual’s emotional experience but also by the emotional communication of society and the media.

Fig. 3.

Trends in positive/negative emotions among the general public

Emotional heat outburst

In July 2022, the World Health Organization announced that monkeypox was classified as a “public health emergency of international concern,” the highest level of an alert issued by the WHO [2]. Since July, the number of monkeypox cases worldwide has rapidly increased from 5,000 to 14,000. The public’s fear and disgust have resonated and strengthened with the increased confirmed cases and the highest level of WHO alert. Individuals obtain information and feedback from the emotional reactions of others, which in turn affects their own emotional state and behavioral decisions. At this time, the public’s attention to the monkeypox epidemic peaked. In August, the emotional heat of Weibo users about monkeypox decreased. Discussions mainly revolved around topics such as “More than 6,600 confirmed cases of monkeypox in the United States,” “31 children in the United States confirmed monkeypox virus”, and “The first case of monkeypox death in India.” At the same time, the first case of monkeypox transmission from human to dog appeared, triggering a new round of discussion. In September, the number of posts rebounded. The main topics of discussion included “The first imported case of monkeypox in Hong Kong” and “One imported case of monkeypox in Chongqing was confirmed,” which indicated that monkeypox had begun to spread in China, quickly causing public concern and panic. Due to risk perception, the public actively seeks information on epidemic prevention and treatment to alleviate the epidemic’s uncertainty and fear, such as vaccine availability, transmission routes, and international spread of the epidemic [22].

In short, public attention increased significantly during this stage, and the public’s emotional heat entered an outbreak period. Among the seven categories of emotions, this article mainly focuses on negative emotions and, for this purpose, selects four categories of emotions: “anger,” “disgust,” “fear,” and “sadness.” A prominent time node is chosen for each stage: May 2022, July 2022, November 2022, July 2023, and November 2023. From the perspective of negative emotions (Fig. 4), the public’s anger, disgust, fear, and sadness are the highest during this stage. In particular, fear and disgust account for a large proportion, which shows that when the monkeypox epidemic spread to China, it directly caused nervous emotions. Based on the knowledge of monkeypox cases in various provinces in China, the public believes that their safety is threatened, thus showing greater fear and worry. In addition, through the understanding of the symptoms of monkeypox-infected people, they show extreme disgust for the monkeypox epidemic. The rise in disgust reflects the public’s concerns about the spread of the epidemic and personal risks.

Fig. 4.

Distribution of four types of negative emotions among the general public

Emotional heat tends to be flat

In the third stage, the emotional heat tended to be flat, and the attention and emotional heat of the monkeypox epidemic on social platforms decreased significantly. The core topics of discussion, “more than 26,000 confirmed cases of monkeypox in the United States”, “75,141 cases of infection reported worldwide”, and “monkeypox cases found in more than 100 countries around the world” focus on the development of the global epidemic, which shows that the monkeypox epidemic spreads quickly and widely. For topics related to China, “China successfully isolated the monkeypox virus” and “Taiwan added four confirmed cases” further clarified at the national level that the prevention of the monkeypox epidemic has made progress. At the same time, the monkeypox epidemic was compared with the COVID-19 epidemic many times in the topics of this stage because both are public health emergencies and are prevalent worldwide. The public began to compare the monkeypox epidemic with other diseases, such as the new coronavirus, to assess its hazards and risks. As experts and scholars popularized the symptoms of monkeypox, public attention was focused on the transmission method of monkeypox and the manifestation of monkeypox rash symptoms. The public gradually adapted to the monkeypox epidemic and was no longer as fresh and nervous as in the initial stage, but more calm and indifferent [27]. In addition, much information about monkeypox has been disseminated and digested, and new information has become less attractive to the public. Adaptive flatness and information saturation have led to a decrease in public attention to monkeypox. On the other hand, the spread of the monkeypox epidemic has been curbed, and the rate of confirmed cases has slowed. On May 11, 2023, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, announced that the monkeypox epidemic no longer constitutes an “international public health emergency.” During this stage, the public’s attention to public posts gradually decreased, and the public’s emotional heat entered a flat period. This stage transitions from tension and fear to calmness and adaptation. From the perspective of emotional classification (Fig. 3), both positive and negative emotions are gradually decreasing and remain relatively balanced. The public’s emotional expression of the monkeypox epidemic is still dominated by fear and disgust. Compared with the previous stages, the public’s fear and disgust towards the monkeypox epidemic have been significantly reduced (Fig. 4). Negative emotions gradually weaken [1]. Public emotions tend to be calmer and more optimistic because the epidemic has been substantially controlled. It is worth noting that the intensity of positive emotions in this stage is significantly greater than that of negative emotions, indicating that the public is more optimistic about the psychological arrangement.

Emotional heat fluctuates

In June 2023, new cases of monkeypox appeared in Beijing, Guangzhou, Hong Kong, Shenyang, and Taiwan, which led to a surge in public discussions about monkeypox. In addition, asymptomatic infections began to appear in some areas, and the public paid more attention to how monkeypox spread. At the same time, rumors about the monkeypox epidemic were rampant on the Internet. It boosted the development of the public psychological crisis. “Shanghai doctors are fully armed to deal with the monkeypox epidemic” once occupied a hot search. After verification by the Shanghai Health and Health Bureau, the rumor was clarified. During the outbreak of the monkeypox epidemic, rumors are very easy to generate and spread, and rumors directly affect the public’s proper understanding of the epidemic. In July, 106 new confirmed cases of monkeypox were reported in mainland China, and 45 confirmed cases of monkeypox were reported in Beijing. The public began to think about the reasons for the increase in monkeypox cases and the protective measures against the epidemic. In August, 501 new cases of monkeypox were confirmed in China. The National Health Commission stated that monkeypox will be included in managing Class B infectious diseases. According to official reports, this round of the monkeypox epidemic is mainly transmitted between men and men. However, the first report of five cases of monkeypox in women showed that the transmission of monkeypox is not limited to men, which aroused widespread concern and discussion in the whole society. According to social cognitive theory, people’s acceptance and understanding of information are influenced by the social environment and the opinions of others. During this period, the number of monkeypox cases in China continued to increase, and the rumors fueled the public’s psychological crisis to a new peak. Compared with the previous period of flat public sentiment, the public’s emotions have risen again. The main reason is that confirmed cases of monkeypox have appeared in various cities in China, and the number of confirmed cases continues to grow. The public’s fear and disgust of the monkeypox epidemic have also gradually increased. Emotional communication theory believes people’s emotions can spread rapidly through social media and traditional media. Once feelings are aroused or panic intensifies, emotional hotspots and continuous discussions will be formed. The continued increase and spread of confirmed cases of monkeypox, as well as related media reports and social media discussions, caused public emotions to heat up again at this stage [74].

In summary, the emotional heat of the fourth stage is mainly affected by the development of the epidemic, media reports, and social media communication. Social psychology theory helps to understand how public emotions are formed, spread, and regulated, and provides theoretical support for the government and health departments to formulate effective public health policies and crisis communication strategies. With the rapid increase in confirmed cases of monkeypox in China and the National Health Commission’s announcement that monkeypox will be included in the management of Class B infectious diseases from the 20th, the public’s attention to public posts increased rapidly during this stage, and the public’s emotional heat rebounded, entering a period of recurrence. It can be seen from the above 21 small categories of sentiment analysis line graphs (Fig. 5) that the public’s fear and disgust emotions increased overall during this stage, which were the primary emotional colors of this stage, and both reached their peak and small peak of emotions in July and September, respectively. In addition, the emotion of disparagement also reached its peak in July and then gradually declined. It can be seen from the analysis of the above seven categories of sentiment analysis bar graphs that the public’s emotions about the monkeypox epidemic at this time are mainly fear, supplemented by disgust, and accompanied by sadness. The degree is greatly improved compared with the previous stage. It can be seen from the above three categories of sentiment analysis line graphs that the positive and negative emotions in this stage are gradually increasing, reaching an emotional climax in July, and then declining progressively with small-scale emotional fluctuations. It is worth noting that the intensity of positive emotions in this stage is always greater than that of negative emotions, and the public is relatively optimistic in psychological arrangement [52].

Fig. 5.

Emotional trends of 21 subcategories of the public

Emotional heat fades

Since September 2023, the monkeypox epidemic in China has gradually stabilized. In October, the main discussion revolved around “the local spread of monkeypox in Beijing has been suppressed” and “the number of new confirmed cases in various places released by the Central Disease Control and Prevention.” This stage highlighted high-frequency words such as “infection,” “female,” and “contact,” indicating that the public has a more significant interest in discussing female-infected people. In addition, words such as “symptoms,” “vaccine,” and “death” indicate that the public is concerned about the symptoms and death of monkeypox patients and looks forward to the development and release of vaccines. Judging from the number of confirmed cases officially announced, the overall prevention and control of the monkeypox epidemic has achieved remarkable results, from 305 confirmed cases in September to 80 cases in November. Judging from the statistics of the four major categories of negative emotions (Fig. 4), the public’s fear and disgust towards the monkeypox epidemic gradually decreased, and there was less sadness. These four types of negative emotions have reached historically low values. From the perspective of 21 sub-categories of emotions (Fig. 5), NC, PH, PE, NN, and NE account for a high proportion. It is worth noting that for the first time, ‘peace of mind (PE)’ exceeded ‘blame (NN),’ indicating that after the government controlled the spread of the epidemic, the public felt more at ease, which, to a certain extent, alleviated the development of the social psychological crisis. At the same time, as the public’s criticism of the government decreases, it is conducive to improving the government’s credibility. With the gradual stabilization of confirmed cases of monkeypox in China, the number of public posts rapidly reduced during this period, the public’s attention and emotions gradually subsided, and the public’s emotional heat entered a period of decline. The public’s attention to the epidemic still exists, but positive emotions have been significantly enhanced. This shows that the public may be optimistic about the control and response measures of the epidemic and believe that the epidemic will gradually be under control. In the face of the gradually stabilizing epidemic, the public shows a more optimistic attitude toward the future, which helps maintain social stability and individual mental health.

Comprehensive analysis

Based on the trend of 24 subcategories of emotions, this study further analyzed the correlation between emotions (Fig. 6). The results showed that the correlation coefficient between “disparagement (NN)” and “disappointment (NJ)” was as high as 0.983, which was a strong correlation. This shows that the public was disappointed with the prevention and control of the monkeypox epidemic and thus disparaged the outbreak to a certain extent. The correlation coefficient between “disgust (ND)” and “suspicion (NL)” was 0.969, the correlation coefficient with “disappointment (NJ)” was 0.968, and the correlation coefficient with “disparagement (NN)” was 0.967, which shows that these four negative emotions are generally expressed at the same time. Different negative emotions are contagious [30].

Fig. 6.

Small category sentiment correlation coefficient matrix

In constructing the correlation network of 21 sub-categories of emotions, the 21 sub-categories are nodes, and the Granger causal relationship between them is defined as edges. The steps are as follows: (1) The set of nodes F in the 21-category correlation network is defined as F={, ,…, , }. (2) The set of edges E in the 21-category correlation network is defined as E={; ; ;…, …, }, where represents the Granger causal relationship between the i-th and j-th nodes.

From the 24-category emotion causal network diagram (Fig. 7), there is a robust causal relationship between different types of emotions. In the causal network, other nodes are interconnected, with no isolated nodes. It can be seen that although the strength of causal relationships between nodes is different, they are interdependent as a whole. In addition, most of the nodes in the figure do not play the role of “bridge,” which means that the nodes form a relatively direct network, and the regulation or mediation effect of the nodes is weak.

Fig. 7.

Small category sentiment causal network diagram

The rationality test

In big data sentiment analysis, it is efficient to automatically determine the emotional tendency of big data through Python. To ensure the accuracy and rationality of the model, this study conducted a rationality test of randomized research interviews. Through random survey interviews, groups of different age groups, genders, occupations, and cultural backgrounds were invited to participate. The interviewees’ emotional feedback results were consistent with the emotional tendencies determined by the model, with a compliance of 92%. This shows a high level of matching.

Furthermore, a single data source may have limitations, such as the possibility of bias in certain emotional expressions on a particular platform. To enhance this research’s rigor and scientific nature, data from two crucial search engine platforms, Google Search and Baidu Search, were introduced to supplement a single data source effectively. The reason for choosing these two platforms is that they have a broad user base, and their search behavior can reflect the public’s attention and interest in an event or topic. This study focused specifically on the search index of the keyword “Mpox,” with the period set from April 2022 to December 2023, which covered the main transmission period of the monkeypox epidemic (Fig. 8). Comparing the search index data of different platforms, it was found that the Baidu search index was highly consistent with the emotional trend based on Weibo data in the previous article. This shows that Baidu’s search can effectively reflect Chinese people’s concerns and emotional changes about the monkeypox epidemic. The Google search index shows specific regional differences related to the development of the monkeypox epidemic in other parts of the world. Next, statistics on search terms related to “Mpox” mainly cover “virus,” “vaccine,” “terrible,” “fear,” etc. The frequency of these words reflects the public’s anxiety and panic about the epidemic. This further confirms the severity of public mood swings during the spread of the epidemic and provides the necessary background and data support for the research in this article.

Fig. 8.

Google and Baidu index statistics for the Mpox topic

Emergency response to public psychological crisis during the Mpox epidemic

Monkeypox virus is an infectious public health emergency that has triggered a severe social and psychological crisis. Based on the analysis of the social and psychological crisis at different stages in the previous article, the corresponding emergency countermeasures will be given below.

Promote accurate information dissemination and ensure transparent communication

Based on the complexity and asymmetry of network information, the government needs to carefully grasp the real progress of the event development during the epidemic. And be able to promptly publicize the real details after the investigation. In particular, exaggerated remarks and rumors should be quickly addressed, and scientific knowledge should be actively disseminated to the public. This approach can effectively reduce negative public emotions. During the pandemic, the government and experts’ information transmission and risk communication are crucial to adjusting the public’s risk perception. On the one hand, official information channels should be established to regularly update information through websites, social media, press conferences, and other channels to ensure the public can access the latest developments regarding the epidemic or events. At the same time, everyday questions from the public should be answered proactively to eliminate their fear of the unknown. On the other hand, an online false information monitoring system should be established to use technical means to monitor rumors and false information on social media and online platforms and refute and correct them promptly [75].

Popularize mental health knowledge and create a good social atmosphere

After the outbreak of a public health emergency, it is essential to popularize relevant mental health knowledge. Establish a community mental health consultation and support network, organize psychological counseling volunteers and professionals, and provide emotional support and psychological education to the affected groups. Issue mental health guidelines or conduct lectures and training to teach the public emotional management and coping skills, such as cognitive reconstruction and emotional release [76].

Improve and perfect the psychological crisis intervention mechanism for public health emergencies

Personalized and professional support should be provided for the mental health needs of different individuals. A psychological hotline should be set up for the general public, and a 24-hour psychological counseling hotline should be established so that people in need can contact psychologists anytime. For patients, comprehensive psychological intervention should be provided promptly. Establishing a psychological support system, carrying out psychological education, forming a patient support group, and implementing personalized intervention can effectively alleviate the psychological crisis of patients and promote their mental health and social integration. For frontline workers, their professional knowledge of mental health should be supplemented, mental health assessments should be carried out regularly, and psychological counseling channels should be set up to ensure mental health [77].

Conclusion and discussion

Research conclusion

Based on social cognitive theory, this paper uses the topic data of monkeypox on Weibo to explore the psychological changes of the public during the monkeypox epidemic and their causes. It also proposes feasible ways to alleviate psychological crises according to the different stages of the monkeypox epidemic. The research found that (1) The external environment is the basis for the public’s psychological turmoil. Whenever the number of confirmed cases of monkeypox increases, the public’s fear and disgust increase. When the scientific research team develops a vaccine or the number of confirmed cases of monkeypox decreases significantly, the public’s panic and disgust will decrease. (2) Subject cognition differences determine the intensity of emotional reactions. In the initial stage of the epidemic, the public lacks sufficient knowledge about monkeypox and is more likely to be afraid. Different subjects also have different cognitions of monkeypox, which leads to other views. (3) The lack of social identity has exacerbated negative emotions for infected people. The transmission method of the monkeypox virus is relatively unique and is limited to specific groups. Some people do not have enough sympathy and empathy for those infected with the monkeypox virus. (4) Collective panic and rumor spread, and they interact. The public may form interest groups with collective behavior patterns when facing a common threat. In the fourth stage, as the number of confirmed cases of monkeypox in China increased rapidly, the public inevitably panicked. Under this collective panic, rumors were quickly generated. For example, rumors such as “Shanghai doctors are fully armed to deal with monkeypox” and “Shanghai outpatient clinics have detected monkeypox” appeared. These rumors intensified the collective panic. (5) Social norms and crisis management shape the stability of public emotions. The World Health Organization and governments of various countries have introduced a series of regulations and systems and promptly disclosed the monkeypox epidemic’s progress. These have played a very critical role in alleviating the public’s psychological crisis.

Discussion

Changes in the external environment directly impact fluctuations in public emotions. This is consistent with the common phenomenon in public health crises, and similar mood swings have also occurred in other public health emergencies, such as the COVID-19 pandemic. Public fear and uneasiness are more prominent when the epidemic information is not transparent [78]. Due to the differences in cognition and information acceptance among different groups, there are significant differences in their understanding of the epidemic [45]. In public health emergencies, there is an asymmetry of information dissemination and a negative impact of speed on public sentiment. Thus, the government needs a timely response and transparent information disclosure to effectively slow down public mood swings [79].

Of course, this study also has certain limitations. This study focuses on the psychological crisis of the public during public health emergencies, and the data only comes from the Chinese Weibo platform. The differences in the responses to public psychological crises on different social platforms can be further explored. Secondly, the extensive data mining method used in this article only grasps the changing process of the public’s psychological crisis as a whole, and it is also meaningful to explore the psychological turmoil of different groups during the epidemic. Finally, the infectious disease epidemic is only one type of public health emergency, and the psychological crisis issues of the public under different types of public health emergencies can be discussed in the future.

Author contributions

Jinsi Liu: Conceptualization, Methodology, Software, Formal analysis, Data curation, Writing – original draft preparation, Writing – review and editing, Visualization. Xiaoqi Wang: Methodology, Writing – original draft preparation. Zhihua Wang: Validation, Writing – review and editing, Visualization. Shixiang Chen: Validation, Investigation, Resources, Supervision, Project administration, Funding acquisition.

Funding

This work was supported partly by the Hubei University Provincial Teaching Research Project “Innovation Research on the Compound Talent Training Model of China’s Administrative Management Disciplines under the Threshold of New liberal arts construction” (Project No.2022014) and “Research on the Optimization of the Management Standardization System of the Hubei Provincial Government” commissioned by the Standardization Department of Hubei Provincial Market Supervision Bureau (Project No. 1203/250000471).

Data availability

Data can be accessed at https://doi.org/10.6084/m9.figshare.27678852.v2.

Declarations

Ethics approval and consent to participate

Ethical approval was not required as the study did not involve human participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.